EMBARGOED FOR RELEASE: 3:15 P.M. (ET) MONDAY, FEBRUARY 22, 2016
Media Advisory: To contact corresponding author Clifford S. Deutschman, M.D., M.S., call Adrienne
Stoller at 516-463-7585 or email adrienne.m.stoller@hofstra.edu. To contact editorial author Edward
Abraham, M.D., call Marguerite Beck at 336-716-2415 or email marbeck@wakehealth.edu.
New Definitions Created for Sepsis and Septic Shock
Updated definitions and clinical criteria for sepsis should facilitate earlier recognition and more timely
management of patients with or at risk of developing sepsis. The report, which appears in the February 23
issue of JAMA, is being released to coincide with its presentation at the Society of Critical Care
Medicine’s 45th Critical Care Congress.
Sepsis, a syndrome of physiologic, pathologic, and biochemical abnormalities induced by infection, is a
major public health concern, accounting for more than $20 billion (5.2 percent) of total U.S. hospital costs
in 2011. The reported incidence is increasing. Although the true incidence of sepsis is unknown,
conservative estimates indicate that sepsis is a leading cause of mortality and critical illness worldwide. In
addition, there is increasing awareness that patients who survive sepsis often have long-term physical,
psychological, and cognitive disabilities with significant health care and social implications.
Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been
made into the pathophysiology, management, and epidemiology of sepsis, suggesting the need for
reexamination. In January 2014, a task force (n = 19) with expertise in sepsis pathophysiology, clinical
trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society
of Intensive Care Medicine to evaluate and, as needed, update definitions for sepsis and septic shock.
Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic
health record databases, and voting, followed by circulation to international professional societies,
requesting peer review and endorsement.
Among the Recommendations

Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host
response to infection.

Septic shock should be defined as a subset of sepsis in which particularly profound circulatory,
cellular, and metabolic abnormalities are associated with a greater risk of mortality than with
sepsis alone.

In out-of-hospital, emergency department, or general hospital ward settings, adult patients with
suspected infection can be rapidly identified as being more likely to have poor outcomes typical of
sepsis if they have at least 2 of the following clinical criteria that together constitute a new bedside
clinical score termed quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA):
respiratory rate of 22/min or greater, altered mentation (mental activity), or systolic blood pressure
of 100 mm Hg or less.
“The debate and discussion that this work will inevitably generate are encouraged. Aspects of the new
definitions do indeed rely on expert opinion; further understanding of the biology of sepsis, the
availability of new diagnostic approaches, and enhanced collection of data will fuel their continued
reevaluation and revision,” the authors write.
The full report is available at the For The Media website.
(doi:10.1001/jama.2016.0287)
Editor’s Note: This work was supported in part by a grant from the Society of Critical Care Medicine and
the European Society of Intensive Care Medicine. Please see the article for additional information,
including other authors, author contributions and affiliations, financial disclosures, etc.
Editorial: New Definitions for Sepsis and Septic Shock
“Although the present definition for sepsis provides needed evolution in categorization of this syndrome,
incorporation of more information about the molecular and cellular characterization of sepsis may have
been helpful,” writes Edward Abraham, M.D., of the Wake Forest School of Medicine, Winston-Salem,
N.C., in an accompanying editorial.
“Hopefully, the next iteration of this consensus process will take full advantage of the rapidly advancing
understanding of molecular processes that lead from infection to organ failure and death so that sepsis and
septic shock will no longer need to be defined as a syndrome but rather as a group of identifiable diseases,
each characterized by specific cellular alterations and linked biomarkers. Such evolution will be required
to truly transform care for the millions of patients worldwide who develop these life-threatening
conditions.”
(doi:10.1001/jama.2016.0290; Available pre-embargo to the media at http:/media.jamanetwork.com)
Editor’s Note: The author has completed and submitted the ICMJE Form for Disclosure of Potential
Conflicts of Interest and none were reported.
Related JAMA Articles, available at the For The Media website:
Assessment of Clinical Criteria for Sepsis
Christopher W. Seymour, M.D., M.Sc., of the University of Pittsburgh School of Medicine, and
colleagues
Developing a New Definition and Assessing New Clinical Criteria for Septic Shock
Manu Shankar-Hari, M.D., M.Sc., of King’s College London, and colleagues
###